超音波Power Doppler法が診断に有用であった原発性精巣上体腺癌の1例

Abstract

68歳男性.右陰嚢内に腫瘤を自覚した.触診では, 右精巣上体頭部に無痛性で母指頭大の腫瘤を触知した.超音波断層法では, 右精巣上体頭部に一致して, 内部エコーが不均一な腫瘤が認められ, パワードップラ法では同腫瘤内に豊富な血流信号を認めた.以上の検査所見より, 右精巣上体腫瘍を疑い, また悪性の可能性も否定できず, 右鼠径切開にて手術を行った.右精巣上体頭部は硬く腫大し, 精巣と強く癒着していたため, 精巣上体を精巣と一塊にして摘出した.摘出標本の病理組織学的検査により, 精巣上体中分化型腺癌と診断した.また, 精巣上体腺癌の殆どは転移性であるため, 術後に原発巣の検索を行い, 原発性精巣上体腺癌と診断した.術後17ヵ月現在, 再発転移の徴候なく, 生存中である

A 68-year-old man presented with right intrascrotal swelling. On palpation, a hard tumor without pain was recognized at the head of the right epididymis. Power Doppler ultrasonography revealed blood flow signals within the tumor. Surgical exploration was performed under the tentative diagnosis as possible malignant tumor of the epididymis. The right epididymis adhered to the testis so strongly, that the epididymis was resected with the testis. Pathological diagnosis was moderately differentiated adenocarcinoma of the epididymis. The results of general examinations on possible presence of primary lesions in other organs were all negative. Finally, the diagnosis of primary adenocarcinoma of the epididymis was obtained. He remains free of disease 17 months after surgery.